"Application Form Word Version"
Application form Post applied for: Post reference number: Where did you see this vacancy advertised? Personal details Title: Address: Surname: Forename: Contact telephone number(s): Email address: Are you eligible to work in the UK? Yes No Please note that if you are successful with your application, we will require proof of your eligibility. Present or most recent employment details Title of post held: Name of employer: Type of business: Current salary: Start date: End date: Period of notice required by your present employer: Please give a brief description of your main responsibilities: Previous employment details (Please include details of any unpaid or voluntary work) Title of post Name of Dates Final salary Reason for held employer employed leaving from/to (month/year) Previous employment details (Please include details of any unpaid or voluntary work) Please list the qualifications you have or are currently working towards and state whether they are academic (A) or competency (C) based qualifications. Start with most recent first and include secondary, further and higher education qualifications. Please list all professional qualifications and memberships of any professional bodies. Level of Subject (e.g. Grade (e.g. Date passed Academic or Awarding qualification English, Drug B, level 2) competency body/assessor (e.g. GCSE, Action) based? BTEC) (A or C) Professional training Please list all professional qualifications and memberships of any professional bodies. Training provider Name of course Professional body Qualification/membership number/status Supporting information Please outline below any skills, abilities, knowledge and experience you consider are relevant to the post you are applying for. These may have been gained through paid employment, voluntary work or spare time activities. Please refer directly to the skills and experience outlined in the person specification when completing this section. Criminal convictions and cautions This job is exempt from Section 4 (2) of the Rehabilitation of Offenders Act 1974. This means that you must tell us about any criminal convictions and/or cautions you might have, including any which would otherwise be considered ‘spent’ under the Act. Please write down in the space below each and every conviction, caution and/or bind over order that you have, including details about: a: the type of offence b: the date when it was committed c: the sentence or fine you received. Please also note if you are the subject of any current criminal proceedings, and/or to your knowledge the subject of any current police enquiry. For these purposes ‘current police enquiry’ includes any ongoing enquiry, prosecution, and being on police bail, but does not include cooperation with the police as an actual or potential prosecution witness. If you have no criminal convictions, cautions or bind over orders then write ‘no convictions’ in the space below. We will treat everything you tell us as strictly confidential and will only consider it in relation to this particular application. If you have convictions, cautions or bind over orders, this will not mean that you will automatically be rejected but it is important that you tell us about them now. If we were to employ you and then discover that you had withheld information you could be dismissed. Name: ________________________________________________ Signature: ________________________________________________ Date: ________________________________________________ Criminal records bureau (CRB) Do you have an existing enhanced CRB disclosure under six months old at the date of application? Yes / No If yes, please provide a copy with this application form. Other information Relationships Do you have a relationship with any member of the Board of Trustees, or to any employee of Swanswell? Yes No If yes, please specify name and relationship. Driving licence Do you hold a full driving licence? Yes No Disability status If you have a disability/long-term condition and need any assistance should you be invited to interview, please give details of any adjustments you think would help you: References Please provide details of two people who will provide a reference for you. One of these must be your present or most recent employer. You may include a reference from your academic career. Reference 1 Reference 2 Name: Position: Name of organisation: Address: Telephone number: Email address: Contact before Yes / No Yes / No interview? Data protection The information you provide is subject to the Data Protection Act 1998. As part of our recruitment and equality monitoring process we will collect and store sensitive data about you. We are required by law to obtain your consent to such data being recorded. By signing this form you give your consent to sensitive personal information being recorded and stored under the Data Protection Act 1998 on the understanding that it will be used to provide monitoring and statistical information on recruitment and equalities. If you succeed in your application and take up employment with us, the information you provide will be used to enable us to review and develop employment practices across Swanswell and to provide data to our commissioners and national agencies. Your individual identity will not be revealed alongside any data that is published. Declaration I confirm that the information I have provided on this form is correct. I understand that my application is likely to be rejected, or if I have been appointed, then I am likely to be dismissed if any of the information is proven to be false or if any information is wilfully omitted or suppressed. If I am appointed, the information on this form may be used in accordance with Schedule 2 of the Data Protection Act 1998, to form part of my permanent personal record which will be kept in Swanswell’s Head Office, accessed only by Human Resources and treated as confidential sensitive information. Signature of applicant: Date: Please return your completed application form to: Human Resources Department Swanswell Suite 5 Hilton House Corporation Street Rugby CV21 2DN Or email: email@example.com Any applications received after the closing date will not be considered. Should you require assistance completing this application form, or need it producing in large print, then please contact the HR Department. If you have not been called for an interview within six weeks of the closing date, then this normally means that your application has been unsuccessful. Equal opportunities monitoring form Swanswell is an equal opportunities employer and we select employees solely on their merit, irrespective of their gender, age, ethnic origin or disability status. In order to monitor the effectiveness of our Equal Opportunities Policy, we request all applicants and staff provide the information below. The information does not form part of our selection process, and will be removed prior to short listing. The information you provide us with will be used for monitoring and statistical purposes only. Please complete all sections by ticking the appropriate boxes. Position applied for: Post reference no: Gender: Male Female Your age: Under 21 21-30 31-40 41-50 51-60 Over 60 Ethnic origin Please select one box from the list below which best describes the ethnic group with which you identify. The categories below are those recommended by the Commission for Racial Equality and were used in the last census. White Black or Black British British Black African Irish Black Caribbean Any other white background Any other black background Please specify: Please specify: Asian or Asian British Mixed Indian White & Black Caribbean Pakistani White & Black African Bangladeshi White & Asian Any other Asian background Any other mixed background Please specify: Please specify: Chinese or other ethnic group Sexual orientation Chinese Heterosexual Any other background Lesbian/gay Please specify: Bisexual Prefer not to say Disability status 1. Do you have a disability? Yes No 2. Please read the following and provide details of any condition you have which fits this description: “Any physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities. Long-term is taken to mean the impairment would reasonably be expected to last, or has lasted, 12 months or more”. Dependants Do you carry out a caring role for dependents? (This information is used to monitor our family friendly policies) Children under 18 Other dependents Thank you for your cooperation